Border Medicine: The Pediatric Cardiology Perspective.

Pediatric cardiology and cardiovascular surgery have witnessed significant advancements over the last two decades. In spite of this progress, congenital heart disease (CHD) still remains as one of the major causes of death in infants and young children in the United States. Many patient-related and patient-independent factors influence the outcomes in patients with CHD, one of which is the geographical location. In the US-Mexico border, management and outcomes of patients with CHD are further complicated by additional problems stemming from complex interplay between two different health systems, and socioeconomic disparities. In this article, the authors evaluate the various interplaying factors and describe the difficulties facing the practicing pediatric cardiologists in a US-Mexico border city.

Bilateral acute non-obstructive pyelonephritis presenting as acute kidney injury requiring haemodialysis.

A 54-year-old female patient with hypothyroidism and diabetes mellitus type 2 was brought to emergency room by the family members for acute change in mental status. The laboratory evaluation demonstrated findings consistent with acute renal failure (normal renal function 3 months prior to presentation). She was initiated on hemodialysis due to lack of improvement in renal function. Urine culture done prior to initiation of antibiotics was positive for Escherichia coli, which was later confirmed by renal biopsy. Extensive workup for the cause of renal failure including for connective tissue disease, plasmacytoma, obstruction was negative. She was treated with 6 week course of antibiotics with eventual recovery of her renal function in 4 months.

Case of primary bilateral diffuse large B-cell lymphoma of the ovary with plasmablastic features in an HIV-negative female patient.

A 37-year-old woman from Puerto Rico presented to our clinic with symptoms of an abdominal distension progressively worsening over 1 year. A CT of an abdomen and pelvis with contrast was performed and revealed bilateral large heterogeneous pelvic adnexal masses with large ascites and right pleural effusion. Tumour markers CA 125 was 766 U/mL and lactate dehydrogenase was 654 U/L. She underwent total abdominal hysterectomy, bilateral salpingo-oophorectomy with pelvic lymph node dissection and partial omentectomy. Pathology of ovarian masses revealed a diffuse large B-cell lymphoma. The staging work-up was negative, which pointed towards the diagnosis of primary ovarian lymphoma. The patient completed 8 cycles of cyclophosphamide, doxorubicin, vincristine, prednisolone chemotherapy. After 18 months of chemotherapy completion, she remains in remission.